State of Missouri - Missouri Secretary of State

State of Missouri

John R. Ashcroft, Secretary of State

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Corporations Division PO Box 778 / 600 W. Main St., Rm. 322 Jefferson City, MO 65102

Articles of Termination for Limited Liability Company

(Submit with filing fee of $25.00)

1. The name of the limited liability company is

Charter #:

2. The date the limited liability company's articles of organization were filed:

3. The reason for filing articles of termination is:

4. The effective date of this document is the date it is filed by the Secretary of State of Missouri unless a future date is otherwise indicated:

(Date may not be more than 90 days after the filing date)

5. On

a notice of merger or consolidation or a notice of winding up disclosing the dissolution

Month/Day/Year

was filed with the Secretary of State of Missouri.

6. Any other matters:

In Affirmation thereof, the facts stated above are true and correct: (The undersigned understands that false statements made in this filing are subject to the penalties provided under Section 575.040, RSMo)

Authorized Signature

Printed Name

Date

Authorized Signature

Printed Name

Date

Authorized Signature

Printed Name

Date

Name and address to return filed document: Name: Address: City, State, and Zip Code:

LLC-5 (01/2017)

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